Plagiocephaly

Have a feel of your skull; it is full of lumps and bumps. It is completely normal to have dips and flatter areas but sometimes a large area of flattening can distort the skull. This condition in babies is known as Plagiocephaly or sometimes

‘flat head’ Syndrome  

Causes

According to the BBC, Plagiocephaly has become more common in recent years, at least in America. Statistics show that while only one in sixty babies were affected in 1992, by 1999 one in three suffered from the condition.

One theory for this increase has been put down to the Back to Sleep campaign. In recent years parents have been recommended to lie their children on their backs to reduce the risk of Sudden Infant Death Syndrome (cot death). Young babies spend a long time on their backs, in a car seat, being carried in a baby carrier or lying in someone’s arms, the backs of their heads are under constant external pressure.

It is also believed that a lack of amniotic fluid (fluid surrounding a fetus before birth) may make babies more prone to Plagiocephaly. The journey through the birth canal and the method of delivery can also be contributing factors. Breech babies can become wedged beneath the mother’s ribs, again increasing the chances of a baby having a flat patch on their skull.

Premature babies are at a higher risk because their skulls are softer than full-term babies. Every baby has a soft skull when it is born and it can be forced to grow in different directions quite easily. When the skull is regularly in a certain position, for example, when they are sleeping or because muscles attached to the skull go into spasm (known as Torticollis) areas of the skull maybe pulled or squashed flat.

Signs & diagnosis

Plagiocephaly is usually visible to the naked eye but sometimes the condition may not be obvious and would only be indicated by measurement. The condition can become apparent at different ages, depending on the cause.

A qualified specialist must make diagnosis of the condition but there are signs that can be spotted by parents early on:

• Flattening on one side at the back of the head, with a compensatory bulge in the forehead on the opposite side

• An asymmetrical shaped skull when viewed from above

• A bald spot on the flattened side

• Eyes may appear to have unequal positioningTreatment

In very young babies, Plagiocephaly can sometimes be treated through repositioning: by alternating the way the baby’s head faces when sleeping in the cot and maximising their tummy time during the day. This is sometimes known as ‘Back to sleep, tummy to play’. There are also a number of specialist mattresses and pillows, which can help.

Some babies do reach a level of severity where nature along with the other products will not correct the shape of the head. In these cases a helmet is the best option. This form of treatment is usually only available privately. There are only two NHS hospitals in the UK, Leeds and Bristol, which offer treatment.A Department of Health spokesperson said: "Plagiocephaly can occur for a number of reasons and doctors have found that the condition can often correct itself as a baby starts crawling and sitting up. While the department cannot comment on individual cases, the NHS is always prepared to intervene where a condition requires it and to seek specialist advice where this is needed."

Cranio Helmets work by holding in place the prominent parts of the head and capturing the natural growth in head circumference and channelling it into the areas, which need to 'round out'.

This is why treatment is most effective in the first 12 months - the head grows by around 12cm in circumference in year one, compared to 2.5cm in year two and 1.5cm in year three.

The helmets are worn for 23 hours a day, and treatment time depends on the age of the baby and the severity of the head shape – on average treatment usually lasts between five and seven months.

For further information please contact Headstart4babies Tel: 07703 320747

www.headstart4babies.co.uk

CASE STUDY

Ben Saich was born by rotational forceps to delighted parents Philip and Karen on June 3rd 2004. But after three months, they noticed that something wasn’t quite right: "We realised that Ben could only look to one side and that his head appeared to be flattening on one side at the back," explains Philip. "Our GP explained that it wasn’t a condition called torticollis, where the muscles in one side of the neck are shorter than the other, but that Ben might benefit from some cranial osteopathy to improve his range of vision.

"After four sessions of cranial osteopathy, things did seem to be improving with his neck, but his head shape was getting worse. As he was spending a large proportion of his time lying on his back and looking predominantly one way, his skull was flattening out and his head was transforming into a parallelogram shape."

Philip and Karen continued to discuss the situation with their GP and Health Visitor, only to be told that this was a common problem, which would correct itself in the next few months. At five months Ben’s head shape was deteriorating, and becoming a major cause for concern: "We were becoming so worried that we pushed for a referral to a consultant at Addenbrooke’s Hospital in Cambridge and were told that we would need to wait 17 weeks for an appointment," continues Philip. "In the meantime, quite by chance, Karen bumped into a Mum at a local playgroup whose baby son was wearing a helmet. When

Karen asked why, the Mum told her that her son had a flattened head and the helmet was helping to correct it. Karen took the name of the specialist Dr Chris Blecher and we e-mailed photos of Ben’s head to him the same evening."

Dr Blecher recommended that Philip and Karen have an appointment with him as soon as possible and Ben was diagnosed with severe plagiocephaly – his asymmetry was measured at 21mm. Dr Blecher took a cast of Ben’s head on 15 November 2004 and fitted the helmet two weeks later. At his first six-week check-up his asymmetry had reduced to 5mm, at the next six-week review it was down to 2mm and he graduated at 0mm asymmetry – in front of a BBC camera crew filming a documentary on plagiocephaly for Inside Out – after a further six weeks.

"It was amazing really. Ben took to the helmet with no problems whatsoever – mainly because of his age, and we did notice a change in his head shape very quickly. We were overwhelmed at the first check-up, as an improvement of 16mm in six weeks was beyond our wildest dreams," comments Karen.

Ironically, after ten weeks of the couple’s 17-week wait for the appointment at Addenbrooke’s, their GP received a letter from the NHS consultant saying that he did not want to see Ben in his clinic as he considered it ‘inappropriate’. It was at this time, in January 2005, that Philip and Karen decided to set up a charitable organisation, Headstart4Babies, to raise awareness of plagiocephaly and make parents aware that the option of helmet therapy exists.

They expected to receive one or two enquiries a month, but in the last 15 months have given help and advice to more than 750 families and their website has had over one million hits. "We’ve been incredibly busy handling enquiries and disseminating information. We’ve also had a lot of coverage in newspapers and magazines, and on TV and radio. All in all, in his short life, Ben has been the catalyst for hundreds of young babies to benefit from greater awareness of, and where required treatment for, plagiocephaly and its associated conditions," concludes Philip.

For further information please contact Headstart4babies

e: info@headstart4babies.co.uk 

http://www.headstart4babies.co.uk/